Knowledge, attitude, practice, and fear level of Bangladeshi students toward Covid-19 after a year of the pandemic situation: A web-based cross-sectional study

Introduction In the earlier phase of the pandemic situation, the Government of Bangladesh (GoB) badly suffered to adhere their people to preventive measures probably due to less knowledge and attitude toward Covid-19. To tackle the second wave of coronavirus, the GoB has again enforced an array of preventive measures, but still encountering the same problem after a year of the pandemic situation. As an attempt to find out the reasons behind this, our study aimed to assess the present knowledge and fear level regarding Covid-19, and attitude and practice of students toward Covid-19 preventive measures (CPM). Methods A cross-sectional study was designed and conducted from 15th to 25th April 2021. A total of 382 participants met all the inclusion criteria and were considered for performing all the statistical analyses (Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, Multiple logistic regression, Spearman rank-order correlation). Results All the participants were students aged 16 to 30 years. 84.8%, and 22.3% of participants had respectively more accurate knowledge, and moderate to high fear level regarding Covid-19. And, 66%, and 55% of participants had more positive attitude, and more frequent practice toward CPM, respectively. Knowledge, attitude, practice, and fear were interrelated directly or indirectly. It was found knowledgeable participants were more likely to have more positive attitude (AOR = 2.34, 95% CI = 1.23–4.47, P < 0.01) and very little fear (AOR = 2.17, 95% CI = 1.10–4.26, P < 0.05). More positive attitude was found as a good predictor of more frequent practice (AOR = 4.00, 95% CI = 2.44–6.56, P < 0.001), and very less fear had negative impact on both attitude (AOR = 0.44, 95% CI = 0.23–0.84, P < 0.01) and practice (AOR = 0.47, 95% CI = 0.26–0.84, P < 0.01). Conclusions The findings reflect that students had appreciable knowledge and very little fear, but disappointedly had average attitude and practice toward Covid-19 prevention. In addition, students lacked confidence that Bangladesh would win the battle against Covid-19. Thus, based on our study findings we recommend that policymakers should be more focused to scale up students’ confidence and attitude toward CPM by developing and implementing well-conceived plan of actions besides insisting them to practice CPM.


Unfunded studies
Enter: The author(s) received no specific funding for this work. This study was conducted according to the principles expressed in the declaration of Helsinki. Besides, this study had been approved by the ethical review committee of Rajshahi University. Anonymity and confidentiality were strictly maintained. All respondents gave full informed consent to participate and consent for their data to be used in the publication. If the data are held or will be held in a public repository, include URLs, accession numbers or DOIs. If this information will only be available after acceptance, indicate this by ticking the box below. For example: All XXX files are available from the XXX database (accession number(s) XXX, XXX.).

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The data underlying the results presented in the study are available from (include the name of the third party • All relevant data are within the manuscript and its supporting information files. and contact information or URL). This text is appropriate if the data are owned by a third party and authors do not have permission to share the data. (2020) outlined that adequate knowledge regarding covid-19 is a potential predictor 92 of attitude towards its preventive practice (13,15). To speak the truth, it is indefinite 93 when the coronavirus will go away from the world. Therefore, people must be

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The questionnaire prepared after a thorough review of some literature published last account for their reasons why they are aberrant than those who answered "Yes".

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There were 17 possible responses and multiple responses could be selected.

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As to scoring, in the knowledge scale, the correct answer (Right) was coded as 1 and 151 the incorrect answer (Wrong/Don't know) was coded as 0. The total score ranged 152 from 0 to 12 where those who obtained 83% score or greater (≥ 10) were considered 153 to have more accurate knowledge otherwise considered having less accurate 154 knowledge. Instead of 80% score, 83% score was considered to avoid fractional 155 digits as all the knowledge scores were integer numbers.

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In the attitude scale, four kinds of options were coded as follows, 0 (No/ Not possible 157 for work), 1 (Maybe), and 2 (Yes). The total score ranged from 0 to 16. Those who 158 had an 81% score or greater (≥ 13) were considered to have a positive attitude 159 otherwise considered to have a less positive attitude. Instead of 80% score, 81% 160 score was considered to avoid fractional digits as all the attitude scores were integer 161 numbers.

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Three options of the practice scale were coded as follows, 0 (No), 1 (Sometimes), 163 and 2 (Yes). The total score ranged from 0 to 16. Those who had an 81% score or 164 greater (≥ 13) were considered to have more frequent practice otherwise considered 165 having less frequent practice. Instead of 80% score, 81% score was considered to 166 avoid fractional digits as all the practice scores were integer numbers. The fear scale had 7 items where each item had five Likert options which were coded 168 as follows, 0 (Strongly disagree), 1 (Disagree), 2 (Neutral), 3 (Agree), 4 (Strongly 169 Agree). The total score ranged from 0 to 28. Fear scores greater or equal to 21 were 170 cut-points for high fear. Scores between 20-14 were cut points for moderate fear and 171 scores equal to or less than 13 were cut points for less fear.

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Reliability tests were performed using field data to determine the validity and   data processing including data duplication-checking, data cleaning, data coding, etc.

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In this stage, three data fallen out of inclusion criteria of age (below 15 years of old), 188 and two data got duplicated were discard from the preliminary dataset. After     (Table 03). Mann-Whitney and Kruskal-Wallis tests 280 unfolded that fear score among participants varies with only gender (P < 0.001). It 281 was reported that females had a significantly high fear score than males (Table 04).

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Multiple logistic regression analysis detected gender, knowledge, attitude, practice, 283 as significant factors that can predict whether an individual would have very little 284 fear rather than high to moderate fear. It was found that male participants were 89% 285 more likely to have very less fear than female participants (AOR = 1.89, 95% CI = 286 1.05-3.40, P < 0.05) (Table 05). Spearman rank-order correlation tests explored that knowledge score is significantly 292 correlated with attitude score (P < 0.01) although it was insignificantly correlated 293 with other scores (practice and fear score). However, attitude score was positively 294 correlated with both practice score (P < 0.001) and fear score (P < 0.001). Along 295 with attitude score, practice score and fear score was positively correlated with each 296 other (P < 0.01) (Table 06). Multiple logistic regression analysis uncovered that 297 participants who had more accurate knowledge were 2.34 times more likely to have 298 a more positive attitude (AOR = 2.34, 95% CI = 1.23-4.47, P < 0.01) and 2.17 times 299 more likely to have very little fear (AOR = 2.17, 95% CI = 1.10-4.26, P < 0.05) than 300 those who had less accurate knowledge; Participants who had a more positive 301 attitude were 4 times more likely to have more frequent practice than those who had 302 less positive attitude (AOR = 4.00, 95% CI = 2.44-6.56, P < 0.001). Moreover, 303 participants who had very less fear were 56% less likely to have more positive 304 attitude (AOR = 0.44, 95% CI = 0.23-0.84, P < 0.01) at the same time 53% less likely to have more frequent practice (AOR = 0.47, 95% CI = 0.26-0.84, P < 0.01) 306 than those who had high to moderate fear (Table 05).

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317 Table 06 Results of spearman's rank-order correlation among knowledge, attitude, practice, and fear score. reasons why they were detached from maintaining safety rules properly. Among 325 those who mentioned "No", 56.3% participants mentioned they cannot maintain a 326 social distance because they need to go out for many reasons and need to use public 327 transports where social distance maintaining is not possible while 44.8% participants 328 mentioned they need to go market for daily groceries or many things where they 329 cannot maintain social distance. 28.3% of participants think of themselves as social 330 butterflies and meet with many friends while they do not maintain social distance.   (Table 07) tabulated all the supportive information.  (Table 07) tabulated all the supportive information.  Table 07 Possible reasons why people cannot maintain safety rules of covid-19 completely.

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Beliefs that I will not be infected by the coronavirus.      account for their reasons why they are aberrant than those who answered "Yes".

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There were 17 possible responses and multiple responses could be selected.

150
As to scoring, in the knowledge scale, the correct answer (Right) was coded as 1 and 151 the incorrect answer (Wrong/Don't know) was coded as 0. The total score ranged 152 from 0 to 12 where those who obtained 83% score or greater (≥ 10) were considered 153 to have more accurate knowledge otherwise considered having less accurate 154 knowledge. Instead of 80% score, 83% score was considered to avoid fractional 155 digits as all the knowledge scores were integer numbers.

156
In the attitude scale, four kinds of options were coded as follows, 0 (No/ Not possible 157 for work), 1 (Maybe), and 2 (Yes). The total score ranged from 0 to 16. Those who 158 had an 81% score or greater (≥ 13) were considered to have a positive attitude 159 otherwise considered to have a less positive attitude. Instead of 80% score, 81% 160 score was considered to avoid fractional digits as all the attitude scores were integer 161 numbers.

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Three options of the practice scale were coded as follows, 0 (No), 1 (Sometimes), 163 and 2 (Yes). The total score ranged from 0 to 16. Those who had an 81% score or 164 greater (≥ 13) were considered to have more frequent practice otherwise considered 165 having less frequent practice. Instead of 80% score, 81% score was considered to 166 avoid fractional digits as all the practice scores were integer numbers.

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Page 9 of 34 The fear scale had 7 items where each item had five Likert options which were coded 168 as follows, 0 (Strongly disagree), 1 (Disagree), 2 (Neutral), 3 (Agree), 4 (Strongly 169 Agree). The total score ranged from 0 to 28. Fear scores greater or equal to 21 were 170 cut-points for high fear. Scores between 20-14 were cut points for moderate fear and 171 scores equal to or less than 13 were cut points for less fear.

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Reliability tests were performed using field data to determine the validity and who are student and self-employed, and came from a lower-class family had 243 significantly less attitude than their counterparts. (Table 04)  Spearman rank-order correlation tests explored that knowledge score is significantly 292 correlated with attitude score (P < 0.01) although it was insignificantly correlated 293 with other scores (practice and fear score). However, attitude score was positively 294 correlated with both practice score (P < 0.001) and fear score (P < 0.001). Along 295 with attitude score, practice score and fear score was positively correlated with each 296 other (P < 0.01) (Table 06). Multiple logistic regression analysis uncovered that 297 participants who had more accurate knowledge were 2.34 times more likely to have 298 a more positive attitude (AOR = 2.34, 95% CI = 1.23-4.47, P < 0.01) and 2.17 times 299 more likely to have very little fear (AOR = 2.17, 95% CI = 1.10-4.26, P < 0.05) than 300 those who had less accurate knowledge; Participants who had a more positive 301 attitude were 4 times more likely to have more frequent practice than those who had 302 less positive attitude (AOR = 4.00, 95% CI = 2.44-6.56, P < 0.001). Moreover, 303 participants who had very less fear were 56% less likely to have more positive 304 attitude (AOR = 0.44, 95% CI = 0.23-0.84, P < 0.01) at the same time 53% less likely to have more frequent practice (AOR = 0.47, 95% CI = 0.26-0.84, P < 0.01) 306 than those who had high to moderate fear (Table 05).   *P ≤ 0.05, **P ≤ 0.01, ***P ≤ 0.001, High to moderate fear = equal or more than 50% fear score, Very less fear = less than 50% fear score.

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317 Table 06 Results of spearman's rank-order correlation among knowledge, attitude, practice, and fear score.  (Table 07) tabulated all the supportive information.  (Table 07) tabulated all the supportive information.  Table 07 Possible reasons why people cannot maintain safety rules of covid-19 completely.

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Beliefs that I will not be infected by the coronavirus.